By Malia Maier, Goleen Samari, and Terry McGovern
In 1973, in Roe v. Wade, the United States (US) Supreme Court affirmed that access to safe and legal abortion is a constitutional right. However, abortion rights in the US have since been under fierce attack. In the 48 years since Roe, state legislatures have enacted 1,320 abortion restrictions, including 573 restrictions enacted in the past 10 years. In 2020, government officials exploited the pandemic response to further restrict access to abortion and sexual and reproductive health and rights (SRHR).
We conducted a mixed method study to investigate how COVID-19 affected SRHR service provision in the US during the first six months of the pandemic. In our review of state-by-state emergency response policies, we found that 14 states acted to suspend abortion by excluding it from the list of essential or non-elective services allowed to continue during shutdowns. This included four states – Indiana, Ohio, Tennessee, and West Virginia – that designated some SRHR services essential while also acting to suspend abortion. Only 12 states explicitly protected abortion. States like Massachusetts, for example, specifically stated abortion is not considered a non-essential or elective procedure. Other examples include Washington, which designated the “full suite of family planning services” as non-elective procedures, and Minnesota, which exempted all reproductive health providers from stay-at-home orders.
Our survey of 40 SRHR service providers and interviews with 15 SRHR service providers and advocacy organizations elucidated the critical implications these policies — or lack thereof — had on provision of, and access to, SRHR services, particularly for historically oppressed populations, during the pandemic. Over half (53%) of survey respondents reported their SRHR work stopped or was reduced due to lockdowns/movement restrictions early in the pandemic. Others reported their work was deemed non-essential and thus was forced to stop (20%). Survey respondents identified groups lacking services including adolescents (20%), women with disabilities (18%), black, indigenous, and people of color (30%), migrants, refugees, and displaced populations (28%), and lesbian, gay, bisexual, trans, and queer (LGBTQ) individuals (20%).
During interviews, abortion providers cited exemptions from state emergency orders as critical. Those who were forced to navigate abortion bans and travel restrictions reported having to delay or cancel services. One provider discussed how a neighboring state’s COVID-19 policy response impacted their service demand:
“All the [state] abortion clinics were closed…so that affected our clinic hugely because basically every patient that was needing an abortion in [state] was going somewhere else and our clinic was one of the main places… So for maybe 2 months it was just crazy… we were way understaffed for that level of patients coming in, so we were all working super long hours. Plus, we were implementing all of these new protocols.”
Abortion providers were also forced to navigate new COVID-19 social distancing protocols, which impacted care provision. For example, abortion providers booked appointments on a staggered schedule and reworked the physical layout of their clinics. Interviewees also had difficulty obtaining personal protective equipment (PPE) and finding local clinicians when it was difficult or impossible for out-of-state providers to travel. One provider noted a shift in utilization of abortion services as a result of COVID-19:
“[Young people] were not able to find any excuse to get out of the house, to go to the clinic, to go to the courthouse, or to get the abortion. So we did see a decrease in people that actually followed through the whole process.”
These state restrictions on abortion in response to the first six months of the COVID-19 pandemic disproportionately impacted people of color, immigrants, people with low income, adolescents, LGBTQ, indigenous, and uninsured or underinsured individuals, directly threatening human and reproductive rights.
Unfortunately, as US officials have eased pandemic-related restrictions, the attacks on abortion have only intensified. In just the first half of 2021, state legislatures across the country have enacted 90 abortion restrictions — more than any other year to date. Last week a near-total ban on abortion took effect in the state of Texas after the US Supreme Court refused to block it. The law bans abortion after about six weeks of pregnancy — before most people even know they are pregnant. Further, it places a bounty on abortion advocates, awarding $10,000 to any private citizen who successfully sues anyone who performs or “aids and abets” an abortion procedure. This assault on SRHR will have immediate and dangerous consequences for both patients and providers.
Months prior to the Supreme Court’s silence on Texas’ unconstitutional abortion law, the Court had already agreed to hear a case (Dobbs v. Jackson Women’s Health Organization) involving a Mississippi law that seeks to ban most abortions after 15 weeks of pregnancy. This case is a direct threat to Roe v. Wade and gives the US Supreme Court’s expanded conservative majority an opportunity to undo nearly five decades of precedent. Weakening or eliminating federal abortion protections could have devastating impacts for people seeking abortion care, especially for those living in US states with hostile abortion laws and for historically oppressed groups. As one interviewee put it:
“Communities of color and rural communities, for us getting the word out about our services is a challenge in itself. And black and brown and indigenous communities, I think all of the barriers to care they were facing before have been exacerbated overall.”
For all people and groups, abortion is fundamental to reproductive justice. Abortion rights are human rights. Now, more than ever, in the US and around the world, we must fight to protect the fundamental human right to health and reproductive freedom.
Malia Maier, MPH is Senior Program Officer in the Heilbrunn Department of Population and Family Health at Columbia University Mailman School of Public Health. She works in the Program on Global Health Justice and Governance on sexual and reproductive health and gender-based violence research and advocacy, and conducts community-based participatory research in school-based health centers to improve adolescent health.
Goleen Samari, PhD, MPH, MA is Assistant Professor in the Heilbrunn Department of Population and Family Health and Program on Global Health Justice and Governance at Columbia University Mailman School of Public Health. She is a public health demographer who is recognized for her research on structural inequities, immigrant health, and sexual and reproductive health and rights.
Terry McGovern, JD serves as Chair of the Heilbrunn Department of Population and Family Health and Director of the Program on Global Health Justice and Governance at Columbia University Mailman School of Public Health. She is a health and human rights activist who founded the HIV Law Project and worked in the Gender, Rights and Equality Unit of the Ford Foundation, and whose current work includes evidence-based approaches to address structural barriers to the achievement of health and human rights.